New Haven Health Department 2011 Annual Report

John DeStefano, Jr. Mayor

Dr. Mario Garcia, MPH Director of Public Health

Ensuring the health and well-being of all New Haven residents.

NEW HAVEN HEALTH DEPARTMENT MISSION

To advocate for and ensure the health and well-being of all New Haven residents.

TABLE OF CONTENTS

Mission Statement Inside front cover

Table of Contents 1

New Haven Health Department Program Structure 2

Letter from the Director of Public Health 3

2011 Health Department Highlights 4

Towards Health Equity: Envisioning a Healthy City 6

Public Health Nursing 7

Combating Asthma in New Haven 10

Environmental Health 12

Consumer Protection 18

Maternal and Child Health 19

Health Programs 22

Epidemiology 25

Vital Statistics 28

Preventive Medicine 29

Emergency Preparedness 31

Administrative Services 33

New Haven Health Department Organizational Chart 35

New Haven Health Department Contact Information 36

New Haven Board of Health Members 41

New Haven Health Department Executive Staff 41

Map of New Haven 42

1 New Haven Health Department Program Structure - 2011

2 Letter from the Director of Public Health

Dear Fellow Elm City Resident:

The New Haven Health Department staff is proud to continue a tradition of fulfilling and assuring the interest of City residents to have conditions in which people can be healthy. Over the last year, the various programs in the Department tracked and monitored trends of communicable diseases, ensured the safety of the food delivery system, continued educating the public on health issues, assisted parents and children at high risk, and prepared for and responded to disease outbreaks and emergencies. This past year, the Health Department also aligned efforts with the City priorities around school reform by both strengthening the organization and delivery of nursing services and focusing on projects such asthma control and improved nutrition, which ensure students are healthy and fit to obtain academic success.

As the practice of public health has shifted over the years to focus on prevention of chronic diseases, the Department strives to structure its organization and programs to address newer challenges such as health inequities and the increasing burden of chronic disease risk factors. To address disparities in health outcomes, the New Haven Health Department is embracing a form of public health practice, which questions traditional thinking and prevailing assumptions. While the agency maintains a service-oriented mission, the Department has also sought to enhance its capacity to process local health information and to attract resources from government and private funding agencies.

The Health Department, as many other health authorities across the nation, is carefully tracking the developments associated with the implementation of the Affordable Care Act. With the enactment of this law came the creation of the most substantial effort in a long time to fund Public Health infrastructure, community-based health programs and prevention initiatives. This includes the creation of the largest ever Prevention and Public Health Fund and the issuing of the first National Prevention Strategy, which offers an unprecedented opportunity to build up the necessary local infrastructure for carrying out comprehensive public health functions. The New Haven Health Department continues building partnerships to access those resources and to enhance municipal capacity to reduce health disparities and promote conditions for a healthier City.

Mario Garcia, MD, M.Sc. MPH Director of Public Health

3 2011 HEALTH DEPARTMENT HIGHLIGHTS

Budget Staff General Funds $3,075,491 56 Special Funds $15,911,601 32 Fees Revenue $900,000 N/A

BUREAU OF PUBLIC HEALTH NURSING  The Bureau provided school health nursing services for approximately 20,000 pre- kindergarten through twelfth graders at 50 public and non-public school sites in New Haven. Of those students enrolled in the New Haven school system, 5,909 have at least one identified health problem.

ASTHMA  The mission of the Asthma Initiative is to reduce associated morbidity and mortality, reduce the number of lost days of work and absenteeism at school, and improve quality of life for people with asthma in New Haven.  The Asthma Initiative has provided 100-200 people with asthma management supplies, as well as funded educational outreach to hundreds of City residents annually.

BUREAU OF ENVIRONMENTAL HEALTH  The Bureau of Environmental Health held its Eleventh Annual Lead Awareness Picnic in the carousel building on June 12, 2011 at Lighthouse Point Park. The event drew over 450 participants.  The Bureau’s fourth U.S. Department of Housing and Urban Development (HUD) Lead Hazard Control Grant which began on January 1, 2009, ended on December 31, 2011. Through this program over 234 privately owned housing units were lead abated with the $2,000,000 in federal funds made available as deferred forgivable loans.

CONSUMER PROTECTION – WEIGHTS AND MEASURES  The Weights and Measures staff inspected 417 small capacity scales, 21 large capacity scales, 378 gas meters and 2 taxi meters.  The total 2011 revenue produced by the staff was $32,122.

MATERNAL AND CHILD HEALTH DIVISION  In fiscal year 2011, the MCH Division’s HUSKY Program enrolled 989 pregnant or postpartum women and 759 children. One thousand two hundred thirty seven (1,237) clients were identified as self-pay or uninsured.  The Division’s Nurturing Families Network (NFN) Program served 49 families in FY 2010-2011, including 59 children, completed 725 home visits, and conducted group sessions during which 18 families with 27 children participated.

HEALTH PROGRAMS DIVISION  The Health Department continued its partnership with Yale University’s CARE Program and other community organizations to implement the Healthy Corner Store Initiative. The Initiative was launched in the spring of 2011, with 4 stores selected to participate.  For the sixth consecutive year, Health Department staff co-led Safe Kids Greater New Haven with Quinnipiac University’s Occupational Therapy Department. “Safe Kids” is a worldwide organization dedicated to reducing unintentional injury and death among children under the age of 15.

4  Ryan White Part A was awarded more than $7 million in 2011 to provide care services in New Haven and Fairfield counties. The Program provided services to 3,482 people living with HIV/AIDS in the region, of which 863 were New Haven residents.  The Health Programs Division secured an additional three years of funding for the Syringe Exchange Program from the CT Department of Public Health.  HIV Prevention staff distributed 36,934 syringes, provided 29 injection drug users with access to substance abuse treatment facilities, tested 279 individuals for HIV, and recruited 336 individuals to participate in the effective behavioral interventions, Safety Counts and Voices/Voces.

HEALTH INFORMATION SERVICES: EPIDEMIOLOGY  As part of the Health Equity Alliance and Health Matters!, Epidemiology led the development of a report on the public health impact of obesity in New Haven.  Epidemiology participated in the development of a Community Health Needs Assessment and Health Improvement Planning process for New Haven in collaboration with Yale New Haven Hospital, Hospital of Saint Raphael, Yale School of Public Health, the New Haven Federally Qualified Health Clinics and DataHaven.

HEALTH INFORMATION SERVICES: VITAL STATISTICS  The Office of Vital Statistics preserves and records all births, deaths, civil unions and marriages that occur in New Haven or occur outside of the City to New Haven residents.  In 2011, a total of 37,605 records were issued by the Office of Vital Statistics, including 1,298 marriage licenses, 10,888 certificates of death, and 17,148 certificates of birth, for a total revenue of $694,685.

PREVENTIVE MEDICINE  The Health Department distributed more than 400 seasonal flu vaccines at sites throughout the community, including Senior Citizens Centers, City Hall, Ecuadorian Consulate, and the Health Department clinic.  The STD Clinic saw a total of 910 patients, diagnosed 34 cases of gonorrhea and 98 cases of Chlamydia, conducted 746 Syphilis tests, and tested 824 individuals for HIV/AIDS.

OFFICE OF EMERGENCY PREPAREDNESS  The Health Department staff distributed public health information; delivered food, water and ice to citizens in need; and inspected and monitored food establishments to ensure food safety as part of the Tropical Hurricane Irene response.  The Office conducted a regional, full-scale exercise entitled “Rad-X.” The goal of the initiative was to give appropriate antibiotic prophylaxis to critical staff of local government, community institutions, and their families, quickly enough upon recognition of a confirmed anthrax attack to protect responders and to off-set the number of people who will be asked to come to the public point of dispensing site. This exercise demonstrated the Health Department can distribute and dispense medications in a timely manner and communicate effectively within established City and State communication channels.

5 HEALTHMATTERS! ENVISIONING A HEALTHY CITY

Health is impacted by more than individual wide spectrum of community organizations behaviors and environmental factors; it is and agencies that meet monthly to help also impacted by social conditions, such as chart a course towards healthier education, transportation, employment, and communities. The initiative’s three aims are: housing. These conditions are known as the 1) Change the way we talk about health; “social determinants of health.” The inclusion 2) Leverage existing health promoting of social determinants of health initiatives for greater impact; and acknowledges that where people live, learn, 3) Create and support policy that work, and play has a significant impact on promotes a healthier community. their health. The Department has VISIONING A HEALTHIER NEW HAVEN incorporated this broader, more inclusive HealthMatters! in collaboration with the HEA, definition of health into its work in an effort to held a community-wide conference titled reduce disparities and improve the City’s “HealthMatters: Visioning a Healthier New overall health. Haven.” The conference included a keynote HEALTHMATTERS! speech from Amanda Navarro, MPH, of In 2009, the Health Department launched PolicyLink, Inc., panel presentations on the Health Equity childhood obesity and community safety, Alliance (HEA) to and the debut of the film “Visions of a focus on the Healthier New Haven.” The conference was underlying causes well attended and began the process of of health charting the course for New Haven to disparities in New Haven, with the become one of the Nation’s healthiest cities. overarching goal of assuring all community LOOKING AHEAD… members have an equal opportunity to The Health Department will continue to work experience optimal health. The HEA was towards a healthier New Haven through established as a two year project, which implementation of health programs. Future completed in 2011. As a result of the HEA, activities include, but are not limited to, the the City of New Haven established the collaboration with community healthcare ongoing initiative HealthMatters! – an providers to implement a community health initiative to improve the City’s health status assessment, the release of a policy brief with the ultimate goal of making New Haven regarding obesity in New Haven, and the one of the healthiest cities in the Nation. implementation of smoke-free rental policies. HealthMatters! has representation from a

6 PUBLIC HEALTH NURSING

The Bureau of Nursing is committed to center, which provides a staff physician to ensuring an optimal level of wellness for a serve as the School District Medical Advisor. culturally diverse urban community by The Bureau provides a variety of school promoting and encouraging a healthy health services, including, but not limited to: lifestyle for its residents. Through the  Immunizations and physical exam delivery of health care services, education compliance tracking; and counseling, and partnership with  Vision and hearing screenings;  First aid (trauma, allergies); municipal agencies and community  Diagnosis & treatment of illness & injuries; organizations, the Bureau identifies and  Medication dispensing; and  Individualized health care plans development. assesses school and community needs to promote safety and disease prevention. In addition to the services provided directly by staff, the Bureau partners with the Helen SCHOOL HEALTH SERVICES Keller Worldwide ChildSight® Program to A student’s health status is directly related to conduct vision screening and provide his or her ability to learn. Children with eyeglasses to middle school students. unmet health needs have a difficult time engaging in the educational process. The THE CHILDREN’S CLINIC Bureau provides school health nursing The Children’s Clinic is held Tuesdays and services for more than 20,000 pre- Thursdays the first few weeks of the school kindergarten through twelfth graders at 50 year at the Department. Physical exams public and non-public school sites in New and immunizations are provided to students Haven, ensuring health-related barriers to enrolled in New Haven schools.

learning are addressed. The Public Health PROTECTING AGAINST CHILDHOOD Nursing Director oversees the Bureau staff, DISEASES which includes 29 Public Health Nurses In order to assure children remain up-to-date assigned to school sites throughout the City, with their immunizations and that their a Pediatric Nurse Practitioner assigned to vaccination records are available when they the Katherine Brennan School-Based Clinic, need them, the Connecticut Legislature and a Clinic Charge Nurse responsible for authorized the State Department of Public various Health Department clinics. The Health to establish a confidential Bureau also has an Audiometrist who computerized registry of preschool-aged performs State mandated hearing children and their immunization records. screenings for students. The Bureau Immunization coverage reports are partners with the Cornell Scott Hill Health generated for all CT pediatric practices Center, a locally federally qualified health based on a child’s immunization status on

7 their 2nd birthday. Children born in 2008 are tracked through 2010 and the data are verified and reported in 2011. From the 2008 birth cohort, 1,865 New Haven area children were enrolled in the Connecticut Immunizations Registry and Tracking System (CIRTS) Registry.

Maternal and child health immunizations rates for the 2008 birth cohort were 78%. Parents may obtain a copy of their child’s immunization history by calling (203) 946- 7097 or the State Immunization Program, Department of Public Health at (860) 509- 7929. Proper identification is required.

EDUCATIONAL OPPORTUNITIES The Bureau is committed to educating the next generation of public health professionals. Through an affiliation agreement with both Southern Connecticut State University and the Yale School of Nursing, senior nursing students take part in electives and mentorship programs.

8 Prevalence of Student Health Problems, New Haven Schools, 2010 – 2011

Grades Middle High Health Problems Parochial All K-8 School School Allergy - Bee 25 2 14 0 41 Allergy - Food (life threatening) 216 22 85 30 353 Allergy - Latex/Environmental 193 31 57 19 300 Allergy - Tree Nuts 85 8 20 15 128 Allergy - Peanuts 153 15 33 16 217 Allergy - Medication 123 21 69 10 223 Arthritis 4 1 4 0 9 Asthma 2,272 160 578 90 3,100 Autism Spectrum Disorders 120 12 53 0 185 ADHD / ADD 322 50 118 6 496 Depression 23 9 38 0 70 Eating Disorders 26 9 15 0 50 Other Behavioral / Emotional 128 16 44 0 188 Hemophilia 7 0 0 0 7 Sickle Cell Trait 49 7 16 0 72 Other Blood Dyscrasias 53 3 17 1 74 Cancer 5 0 5 0 10 Cardiac Conditions 75 7 33 0 115 Cerebral Palsy 17 1 18 3 39 Developmental Delays 162 14 27 1 204 Diabetes Type I 24 3 14 0 41 Diabetes Type II 8 2 18 1 29 Lyme Disease 1 0 2 2 5 Migraine Headaches 66 14 26 3 109 Neurological Impairment 73 13 41 1 128 Other Health Impairment 226 43 59 0 328 Oral Health Needs 48 1 6 0 55 Orthopedic Impairment 51 6 25 6 88 Seizure Disorder 101 7 39 2 149 Speech Defects 263 17 21 2 303 Severe Vision Impairment 70 3 30 12 115 Severe Hearing Impairment 58 5 20 5 88 Spina Bifida 8 0 7 0 15 Total Health Problems 5,055 502 1,574 225 7,356 Total Students with at least one 4,050 424 1,247 188 5,909 TOTAL # STUDENT IN DISTRICT 13,539 977 5,251 782 20,549

Students on Medications in School, New Haven Schools, 2010 - 2011

Grades Middle High Medication Parochial All K-8 School School # PRN Meds (i.e., Tylenol, Benadryl) 222 37 118 21 398 # Asthmatic PRN Nebulizers 66 0 2 1 69 # Asthmatic PRN Inhalers 1,105 68 124 50 1,347 # Daily Meds 78 7 13 5 103 # Diabetic Insulin Injections 6 0 9 0 15 # Insulin Pumps 7 2 6 0 15 # Diabetic PRN 28 4 12 1 45 # Epi-Pens 238 18 41 26 323 TOTAL 1,750 136 325 104 2,315

9 COMBATING ASTHMA IN NEW HAVEN

Asthma is a continuing challenge in New asthma and its causes, environmental Haven. The prevalence of asthma in New triggers and treatment. Haven is not substantially higher than GREATER NEW HAVEN REGIONAL ASTHMA statewide average; however, New Haven, INITIATIVE along with other large CT cities, has among The Health Department participates in the the highest incidence of hospital admission Greater New Haven Regional Asthma and Emergency Department visits for Initiative to coordinate asthma-related asthma in the state. In addition, the activities. The Initiative includes likelihood of asthma triggers in New Haven representatives from local health care homes is substantially increased due to agencies, regional health departments, approximately 82% of housing units being Medicaid managed care organizations, and constructed prior to 1979. This is indicative the American Lung Association. of the importance of controlling asthma TRIGGERS BE GONE triggers and enhancing asthma management Triggers Be Gone provides in home asthma within the City. education and triggers identification during ASTHMA INITIATIVE home visits for the low income and The mission of the Health Department’s uninsured families residing in New Haven. In Asthma Initiative is to reduce associated addition, it provides asthma self- morbidity and mortality, reduce the number management and home environmental of lost days of work and absenteeism at control supplies, including medication school, and improve quality of life for people delivery devices, air purifiers, mattress and with asthma in New Haven. This effort pillow covers, dust cloths, and includes: outreach and education, hypoallergenic cleaning solution. Working collaboration through the Greater New with school nurses and medical offices in the Haven Regional Asthma Initiative, and direct community, the program receives client services through the Triggers Be Gone referrals. Through these referrals the program. program maintains a database of baseline information regarding asthma management. COMMUNITY EDUCATION The Asthma Initiative performs extensive The program is collaborating with the community educational outreach to Department's Bureau of Environmental agencies, schools, and others concerning Health on the Green and Healthy Homes initiative.

10 ASTHMA INITIATIVE FUNDING Coordination. Easy Breathing Project is a For the past four years, the program has project aimed at increasing the use of functioned with grant funding from Yale New asthma action plans by providers. ERICCA Haven Hospital and the Community Project is a collaborative effort with Yale Development Block Grant. These funds have University to develop better electronic provided 100-200 people with asthma communication between providers in asthma management supplies, as well as funded care. The Triggers Be Gone referral form is educational outreach to hundreds of City a part of Yale’s Electronic Medical Record. residents annually. Additional support is provided from the Department’s Bureau of Environmental Health and the Maternal and Child Health Division.

ADDITIONAL ASTHMA EFFORTS Early Intervention/Head Start. The Health Department has a partnership agreement with the Head Start program. This allows the Department to reinforce asthma education and provide targeted programming for parents of children with asthma in the Head Start program.

Outreach to Health Care Providers. Reference tools for providers were developed regarding the services and equipment covered by the Medicaid managed care organizations. Contact was made concerning their ability to refer patients for home supplies, to promote use of Asthma Action Plans, and the Asthma Initiative program’s availability to provide asthma education.

The Asthma Coordinator works closely with the Health Department’s school nurses to link children to the appropriate resources.

11 ENVIRONMENTAL HEALTH

The Bureau of Environmental Health FUNDING maintains as its principal goal the Funding for the Bureau is derived from preservation and protection of the various sources, including grants from the environmental quality of the City of New state and federal governments in addition to Haven. Staff utilize and enforce applicable the City of New Haven’s general fund. The sections of the State Public Health Code, Bureau is currently comprised of fourteen full State Statutes, and Municipal Ordinances; and part-time employees. Throughout the license and inspect food service year interns from colleges and local high establishments; resolve cases of childhood schools assist the Bureau. lead poisoning; provide educational outreach INSPECTIONS activities and assist with distribution of A total of 1,692 inspections and re- federal lead abatement funds to prevent lead inspections were performed in 2011 upon poisoning; investigate and resolve public the 1,064 food service establishments health nuisances and infractions of operating within the City of New Haven. Of applicable statutes and/or ordinances; these inspections, 162 indicated a failing monitor water quality of public swimming score which necessitated corrective action pools and beach water; and inspect schools, and re-inspections by staff. daycare centers, senior centers and summer Licensed Food Establishments, New Haven, 2011 lunch feeding sites. Staff also assist in Type # % preparing for and responding to public health Restaurant 448 42.0 Café 80 7.0 emergencies. Institution 61 6.0 School 63 6.0 Caterer 30 3.0 Itinerant vendor 192 18.0 Retail store 149 14.0 Market 8 1.0 Bakery 23 2.0 Processing plant 10 1.0 Total 1064 100

WEST NILE VIRUS PREVENTION Time and resources were devoted to the City’s response to West Nile Virus. For Bureau of Environmental Health Staff several years, plans have been instituted by a host of involved parties to reduce mosquito

12 breeding within the City, to educate the Lighthouse Point Park, in addition to Fort public, and to monitor the spread of the Hale Park (another local beach area) were virus. In 2011, 229 pools consisting of 3,780 found to be of suitable quality for swimming. mosquitoes were trapped within Beaver However, on four different occasions for a Pond Park by researchers from the total of fourteen days this swimming season, Connecticut Agricultural Experiment Station. Lighthouse Beach was closed for public Seven mosquito pools were positive for the bathing. The closure dates were as follows: West Nile Virus and one pool of Anopheles June 2nd to June 6th, June 12th to June 13th, punctipennis was positive for Jamestown August 29th to September 3rd and September Canyon virus. The predominant mosquitoes 5th. All closures except for September 5th trapped at this site were of the species were due to high bacterial counts. The Coquillettidia perturbans, Culex pipiens, beach closure on September 5th was due to Culex restuans, Culex salinarius and Aedes the presence of storm related debris on the vexans. The pools positive for West Nile beach. August 29th to September 3rd high Virus were from two species (C. pipiens, and bacterial counts were due to Tropical Storm C. salinarius) and were trapped between Irene. August 9th and September 13th. The LEAD-BASED PAINT HAZARD CONTROL Jamestown Canyon isolate was collected on The City fits the general profile of a June 27th. jurisdiction with a high level of risk for Certified pesticide applicators from the City’s exposure to lead-based paint by young ® Department of Public Works place Altosid children. Within the city, 32% of the 10,431 XR 150 day Extended Residual Briquettes children under the age of 6 years live below into City-owned catch basins which are the poverty level and 64% of all families earn prone to contain standing water. Although below 80% of the Area Median Income of there are approximately 7,000 catch basins $35,122 with 44% at or below 50% of the on public property within the City, this year Area Median Income, according to 2009 roughly 1,389 contained standing water and American Survey estimates published by the therefore were treated with a larvicidal U.S. Bureau of the Census and early release agent, some more than once. 2010 Census data. New Haven ranks second in Connecticut for the most children WATER QUALITY in poverty, with 12% of the State’s children The water quality at Lighthouse Point Park, living in poverty residing in New Haven. the only public beach within the City, was There is an old housing stock: approximately monitored throughout the summer. The 80% of all housing units were constructed majority of water samples secured from

13 before 1978, with a median year of were utilized to assist owners of occupied construction of 1943 for all housing units. units requiring full abatement due to the There is a significant low income rental presence of a child with elevated blood lead population: 86% of renters living below the levels, and (2) $800,000 in deferred poverty level live in structures built before forgivable loans were utilized to assist in the 1978. There are 42,034 pre-1978 housing creation of lead-safe housing through units with 17,445 units built prior to 1940. rehabilitation of vacant buildings needing lead hazard reduction prior to occupancy by The Bureau was awarded its fourth round of non-profit and/or faith-based housing Lead-Based Paint Hazard Control funding developers creating affordable units. A from the U.S. Department of Housing and Special Considerations Fund ($200,000) Urban Development (HUD) on January 1, was set aside to assist owners of occupied 2009, which concluded on December 31, or vacant buildings being returned to use 2011. During this three year funding period, where there were extraordinary costs to over 234 privately owned housing units were abate or reduce hazards. The request lead abated and 219 of these units were balance ($1,000,000) provided funds to renovated to meet Green and Healthy support community outreach and education, Homes standards established by HUD. The lead testing and abatement specifications, Lead-Based Paint Hazard Control Program, and to staff and implement the program for a as designed, addresses the needs of the three year period. City's distressed and aging housing stock and the physical well-being of its youth. New Haven’s Lead-Based Paint Hazard Control Program is a collaborative partnership consisting of two municipal departments, the Health Department and the Livable City Initiative (LCI), and the Yale/New Haven Lead Program & Regional Treatment Center. Each partner provides services and oversight specific to their field of expertise and municipal responsibility.

Thus far, with four rounds of HUD funding Children participating in the Bureau of Environmental Health’s annual educational outreach event at Lighthouse Point Park. totaling $11,750,000 since 1995, over 1,099 The program addressed two important housing units have been lead abated. Eight sectors of the local housing stock: hundred and twenty-nine (829) of these units (1) $1,000,000 in deferred forgivable loans reached Green and Healthy Homes

14 standards regarding health and safety issues EDUCATIONAL OUTREACH in addition to weatherization and energy efficient appliances and furnaces.

The Bureau has reapplied for additional HUD Lead Hazard Control funding. As the Bureau’s current program exceeded all performance benchmarks and New Haven continues to present a need for such federal assistance, the Bureau is optimistic of a positive response. Lead Poisoning in Children 6 Years of As in prior years, the Bureau celebrated the Age and Under, New Haven, 2002-2010 legacy of Dr. Martin Luther King, Jr. by Children Lead Tested poisoned * participating in a January event to promote Year N N % environmental justice. The event was co- 2002 6,325 448 7.1 2003 6,123 359 5.9 sponsored by Yale University and the State 2004 5,769 385 6.7 of Connecticut Department of Environmental 2005 5,004 332 6.6 Protection. Held at the Peabody Museum of 2006 5,138 299 5.8 Natural History at Yale University, the event 2007 4,791 247 5.2 2008 5,017 259 5.2 was well attended by hundreds of families. 2009 4,627 194 4.2 Bureau staff distributed lead poisoning 2010 4,522 185 4.1 prevention literature and “give away” items *Blood lead level ≥ 10μg/dL Note: 2011 data not available at time of publication stressing the “Lead Free is Best for Me”

There has been a decreasing trend in the message. number of children reported to the Health With resources provided by the public Department with elevated lead levels in their relations firm of Burson-Marsteller (and blood. From 2002 to 2010, the City has previously by Hill & Knowlton), the Bureau of experienced a 41% reduction. Despite the Environmental Health has greatly enhanced decline, New Haven reports the most lead its educational outreach efforts. Funding poisoned children of all Connecticut cities. provided by Benjamin Moore Paint Company The Bureau of Environmental Health has enabled the firm of Burson-Marsteller to maintains a website Newhavenlead.com to train and provide Bureau staff with assist with efforts in reducing the number of interactive educational presentations lead poisoned children in New Haven. designed for various venue sites. An artistically designed presentation booth equipped with a television/video cassette

15 recorder and various “give away” items such (both print and electronic) has also been as t-shirts, pens, sponges, soaps, frisbees extensively utilized this year to spread the and reading materials related to lead lead poisoning prevention message. Radio poisoning prevention have been created to broadcasts, including a radio public service attract and educate participants. announcement read by Mayor John DeStefano, Jr. and Alderman Jorge Perez The lead poisoning prevention educational (who read the message in Spanish), campaign has been an overwhelming television coverage, and newspaper articles success. During the year, over 19,000 appeared throughout the year to bolster the people visited the “booth” at schools, Bureau’s campaign. The radio neighborhood events, community health announcements, which aired daily during the fairs, church picnics, and day care centers in months of October, November, and addition to events sponsored by the Bureau December on two radio stations serving the at Lighthouse Point Park, as well as the greater New Haven area in addition to a “Don’t Spread the Lead” campaign held listing of other radio stations, reached over within hardware stores. Media coverage one million listeners. Bureau of Environmental Health Educational Outreach

16 Childhood Lead Poisoning Investigations by Neighborhood, New Haven, 2005 - 2011

Neighborhood Tract 2005 2006 2007 2008 2009* 2010* 2011* Amity 12 1 3 0 2 4 3 2 Annex 27 1 3 4 1 0 2 3 Beaver Hill 14 5 8 6 7 3 9 2 Dixwell 16 2 6 6 3 1 4 0 Downtown 1 1 0 0 0 0 0 0 Downtown 17 0 0 0 0 0 0 0 Dwight 7 6 9 6 5 2 2 3 East Rock 19 1 1 1 0 3 4 4 East Rock 20 0 0 1 2 1 1 0 Edgewood 9 14 9 24 3 3 4 7 Fair Haven 23 9 14 2 9 8 10 5 Fair Haven 24 8 8 9 5 6 13 7 Fair Haven 25 4 4 4 4 4 5 8 Fair Haven Heights/Quinnipiac Meadows 26 2 8 4 2 3 4 2 Hill 3 3 5 6 2 6 4 4 Hill 4 5 5 4 2 3 7 4 Hill 5 6 5 5 9 9 1 4 Hill 6 3 5 9 8 3 6 5 Long Wharf 2 0 1 0 2 0 0 0 Morris Cove 28 0 0 1 0 0 1 0 Newhallville 15 18 13 7 6 3 5 10 Prospect Hill 18 6 4 1 5 1 1 1 West River 8 5 10 4 9 7 5 4 West Rock 13 2 0 2 0 1 0 2 Westville 10 0 0 1 1 3 5 3 Westville 11 0 0 0 0 0 0 0 Wooster Square 21 0 0 0 1 2 2 2 Wooster Square 22 1 0 0 0 0 0 0 Total --- 103 121 107 88 76 98 82

Note: An investigation may be initiated if a child is found to have a blood lead level of 20μ/dL or greater (after 2008 ≥ 15 µg/dL) or requested by parent/caregiver

* In 2009, 2010 and 2011 values reflect venipunctures ≥ 15 μg/dL.

17 CONSUMER PROTECTION

Consumer Protection is an integral part of The following table outlines the Weights and the Health Department’s operations. The Measures Division’s 2011 activities. Bureau of Weights and Measures is Establishment Number mandated by the State of Connecticut, Grocery stores/Laundromats/ 183 Connecticut State Statutes, Title 43-6, to Wholesale/ Shipping & Packing establishments test and inspect every weighing and 438 inspections, Scales (small and large) tests & rechecks measuring device in the City of New Haven, 35 Gas Stations ensuring consumer protection in the City. establishments Whether it is at the gasoline pump, riding in 378 inspections, Gas Meters tests & rechecks a taxicab, or doing laundry at a laundromat, the staff help ensure consumers are getting State Requests 39 what they pay for in the City of New Haven Consumer Complaints 7 and reducing the likelihood of fraud and misrepresentation of goods. Federal Requests 0

DEVICE INSPECTION SUMMARY Device Type Total Inspected 2011 REVENUE Small Capacity Scales 417 Gas Meters Large Capacity Scales 21 Amount Charged per Meter $45 Gas Meters 378 Number of Meters 378 Taxi Meters 2 Meter Total $17,010

Scales Amount Charged per Scale $36 Number of Scales 438 Late Fees Collected $100 Scale Total $15,868 Grand Total $32,878

18 MATERNAL AND CHILD HEALTH

Made up of fifteen outreach workers and In fiscal year 2011 (July 1, 2010 to June 30, supervisors, with an annual budget near 2011), the MCH Division’s HUSKY Program $900,000, the Health Department’s Maternal enrolled 989 pregnant or postpartum women and Child Health (MCH) Division is and 759 children. One thousand two spearheading the movement to improve hundred thirty seven (1,237) clients were pregnancy outcomes, reduce the infant identified as self-pay or uninsured. Twenty mortality rate and promote family health and four percent (24%) of the clients enrolled in well-being in the City of New Haven. the Healthy Start Program reported a lack of dental care; 2% reported current tobacco The MCH Division provides bicultural and use; 95% identified housing, food, job and bilingual community-based outreach and transportation as concerns, up from 81% case management support for pregnant and reported in 2010; and 51% reported stress parenting women and their families in order as a major issue impacting their lives. to successfully access health care and other Program participants ranged in age from 14 support services. The Division works to to 43 with the majority of births occurring to ensure children are born as healthy as women between the ages of 20 to 34. possible and parents are equipped with the necessary skills to raise their children in a The Division continued to provide a free supportive, nurturing, and safe environment. pertussis vaccination clinic and social

Perinatal Risk Factors - Pregnant and Postpartum Women Enrolled in Federal Healthy Start - New Haven Heatlh Department, FY2011

History of pregnancy complications 11%

History of poor birth outcomes 21%

Stress 51%

Current smoking 2%

Concerned about housing, food, job, transportation 95%

Lacks safe housing 13%

Marginally housed 4%

Lack of dental care 24%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Percentage of Enrollees

19 marketing campaign, “A Circle of Protection,” and the proportion of fathers employed full- targeting immediate and extended family time rose dramatically, from 15% at entry members to address the increase in cases of into the program to 38% two years later. pertussis in newborns. The Division ACCESS TO HEALTH CARE FOR FAMILIES collaborated with the Yale School of Access to health care continued to be a Medicine’s Department of Psychiatry to major focus in 2011. In New Haven, the implement the MOMS Project, a program to Health Department serves as the South address perinatal depression and trauma. Central Connecticut Regional Administrator The goal of the project is to conduct a health for the HUSKY Program providing assessment and strategic action and assistance for pregnant women and their implementation plan to identify issues families applying for health insurance. related to the mental health of pregnant and HUSKY is Connecticut’s State Health parenting women, and work with the New Insurance Program. Clients receive short- Haven Housing Authority. term, limited care coordination, a STRENGTHENING FAMILIES AND comprehensive risk assessment, referrals PROTECTING CHILDREN and follow-up through a partnership The Division’s Nurturing Families Network administered by the Community Foundation (NFN) Program helps clients receive for Greater New Haven’s Federal Healthy parenting, newborn care, and breastfeeding Start Initiative. support, as well as connections to various community resources. In FY2011, tt served 49 families, including 59 children, completed 725 home visits, and provided group sessions in which 18 families with 27 children participated. According to research conducted by the University of Hartford’s Center for Social Research, almost two- thirds of NFN mothers completed high school after two years in the home visiting program (an increase from about half at For more information about MCH programs or HUSKY insurance entry), and the proportion of mothers application assistance, please call employed almost doubled, to about 50%. (203) 946-8187. Fathers’ rates of high school completion also rose to about the same level as the mothers,

20 MATERNAL AND CHILD HEALTH PROGRAMS

CONNECTICUT HEALTHY START, HUSKY INSURANCE APPLICATION ASSISTANCE A Connecticut Department of Social Services funded program that assists pregnant women and their families applying for health insurance. Clients receive short-term, limited care coordination, a comprehensive risk assessment, referrals and follow-up. The New Haven Health Department is the South Central Connecticut Regional HUSKY administrator.

CONNECTICUT HEALTHY START, MATERNAL AND NEWBORN OUTREACH SUPPORT (MANOS) PROGRAM A Connecticut Department of Social Services funded intensive case-management and home visiting program for pregnant women who are identified for being at risk for poor birth outcomes. Services include family re-unification, medical transportation, advocacy, referrals for employment, training and housing, behavioral health and substance abuse treatment.

NURTURING FAMILIES NETWORK (NFN) A Connecticut Children's Trust Fund, Department of Social Services funded program designed to promote positive parenting and reduce incidences of child maltreatment for high risk, first time parents. Components of the program include a focus on fathers (among the first in the nation), support groups (teen and co-ed), and weekly home visiting.

NEW HAVEN HEALTHY START A federally funded program administered by the Community Foundation for Greater New Haven to improve birth outcomes and reduce health inequities for African American women. Healthy Start begins with preconception counseling and includes prenatal, postpartum and infant care and targeted support services that address identified needs.

21 HEALTH PROGRAMS

The Health Department’s Health Programs successful implementation. On-going Division provides a variety of services evaluations are conducted to ensure to including obesity prevention, unintentional effectiveness. The Initiative will expand in injury prevention, and HIV/AIDS services. 2012 to include additional stores. The goals of the Health Programs Division’s UNINTENTIONAL INJURY PREVENTION services are to: 1) reduce the rate of unintentional injury, disability, obesity, chronic disease, and premature death among City residents, and 2) work to reduce the incidence of HIV through identification of new HIV/AIDS cases, linking individuals to medical and social support services, and promoting the adoption of risk reduction behaviors. The Health Programs staff continued to educate residents about child passenger OBESITY PREVENTION and child residential safety. For the sixth The Health Department continued its consecutive year, the Health Education staff partnership with Yale University’s CARE co-led Safe Kids Greater New Haven with Program and other community Quinnipiac University’s Occupational organizations to implement the Healthy Therapy Department. “Safe Kids” is a Corner Store Initiative. The Initiative’s goal worldwide organization dedicated to is to improve residents’ access to healthy reducing unintentional injury and death foods by encouraging local corner stores to among children under the age of 15. stock healthy food options. During 2011, Safety Kids Greater New The Initiative launched in the spring of 2011, Haven participated in the following events, with four stores selected to participate. with over 750 families served and more than Adam’s Deli, Clinton Food Centre, 1,700 educational materials distributed: Congress Market, and the George St. Deli  International Walk to School Day were chosen as the initial four stores based  Environmental Health’s Lead Safety upon their proximity to schools and the Day  Halloween Safety Presentations at store’s level of interest. Each proprietor was Helen St. School and the Keefe provided with education, support, and Center  Yale University’s Youth Day Fair regular follow-up contact to ensure  St. Andrew’s Nursery School Fall Festival

22  Ecuadorian Consulate’s Health Fair to be provided at non-traditional venues. To  North Haven Fire Department’s further increase reach and program Bicycle Helmet Fitting events  Healthy Start Family Fun & Fitness Day visibility, the Division recently purchased a  New Haven Fire Department’s Fire 29-foot mobile outreach van with grant Prevention Kick-off Event  New Haven Employee Wellness Fair funding from the CT Department of Public Health. The van, which is partitioned to RYAN WHITE PART A provide a private space for conducting rapid Ryan White Part A was awarded more than HIV testing, serves as the primary venue for $7 million in 2011 to provide care services the syringe exchange program. in New Haven and Fairfield counties. This funding was distributed to 24 agencies which served a total of 3,482 unduplicated clients. Of the 1,504 people living with HIV/AIDS in New Haven, 863 received Ryan White Part A funded services, including 116 new clients. Ryan White Part

A Services are mandated by the Federal Human Resources and Services During 2011, the program successfully: Administration (HRSA). Seventy-five  Secured an additional 3 years of funding for the Syringe Exchange Program from percent (75%) of all funding must go to the CT Department of Public Health; “core” services (primary medical care,  Distributed 36,934 syringes;  Provided 29 injection drug users with mental health, substance abuse treatment, access to substance abuse treatment; medical case management, oral health, and  Tested 279 individuals for HIV; and  Recruited 336 individuals to participate health insurance) and 25% of funding is in the effective behavioral interventions, allocated to “support” services which must Safety Counts and Voices/Voces. be linked to medical outcomes (medical CONNECTICUT HIV/AIDS IDENTIFICATION transportation, outreach, emergency AND REFERRAL financial assistance, housing assistance, Division Staff participate in the Connecticut and food-bank home delivered meals). HIV/AIDS Identification and Referral Task Force which is working to improve Partner HIV/AIDS PREVENTION SERVICES Notification Services, develop strategies to HIV prevention services are offered identify and test individuals at risk for throughout the City. Relationships contracting or transmitting HIV, and link established with Emanuel Baptist Homeless HIV+ clients to medical and social support Shelter and Christ Church Soup Kitchen services. enables the HIV/AIDS prevention services

23

New Haven Residents Living with HIV/AIDS Receiving Ryan White Part A Services in 2011

Other/ IDU MSM MSM/IDU Heterosexual Perinatal Total Not Specified % of N % N % N % N % N % N % N Total TOTAL 230 26.7% 111 12.9% 11 1.3% 327 37.9% 12 1.4% 172 19.9% 863 100.0% Gender Male 167 33.1% 107 21.2% 11 2.2% 119 23.6% 3 0.6% 98 19.4% 505 58.5% Female 63 17.9% 0 0.0% 0 0.0% 208 59.1% 9 2.6% 72 20.5% 352 40.8% Transgender 0 0.0% 4 66.7% 0 0.0% 0 0.0% 0 0.0% 2 33.3% 6 0.7% Race/Ethnicity White 39 33.6% 31 26.7% 2 1.7% 19 16.4% 0 0.0% 25 21.6% 116 13.4% Black 124 25.3% 52 10.6% 6 1.2% 198 40.4% 8 1.6% 102 20.8% 490 56.8% Hispanic 62 29.4% 21 10.0% 3 1.4% 94 44.5% 3 1.4% 28 13.3% 211 24.4% Am. Indian/AK Native 0 0.0% 0 0.0% 0 0.0% 1 100.0% 0 0.0% 0 0.0% 1 0.1% Asian 0 0.0% 1 100.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 1 0.1% > 1 Race 5 20.8% 2 8.3% 0 0.0% 13 54.2% 0 0.0% 4 16.7% 24 2.8% Other/Unknown 0 0.0% 4 20.0% 0 0.0% 2 10.0% 1 5.0% 13 65.0% 20 2.3% Age < 2 0 0.0% 0 0.0% 0 0.0% 1 100.0% 0 0.0% 0 0% 1 0.1% 2-12 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 34 100% 34 3.9% 13-24 1 2.4% 7 16.7% 0 0.0% 5 11.9% 9 21.4% 20 48% 42 4.9% 25-44 28 12.4% 47 20.9% 2 0.9% 120 53.3% 2 0.9% 26 12% 225 26.1% 45-64 196 36.6% 54 10.1% 9 1.7% 189 35.3% 1 0.2% 86 16% 535 62.0% 65+ 5 19.2% 3 11.5% 0 0.0% 12 46.2% 0 0.0% 6 23% 26 3.0%

% = Row percentages, unless otherwise noted IDU = Injecting Drug User MSM = Men who have sex with men Note: The above chart represents only New Haven residents living with HIV/AIDS who received services through Ryan White Part A. It does not represent the entire population of New Haven residents living with HIV/AIDS, which is discussed in the narrative.

New Haven Residents Who Were New Ryan White Part A Clients in 2011

N % TOTAL 116 100 Gender Male 51 44.0 Female 65 56.0 Race/Ethnicity White 11 9.5 Black 64 55.2 Hispanic 23 19.8 Am. Indian/Alaskan Native 1 0.9 More Than One Race 6 5.2 Not Specified 11 9.5 Risk/Mode of Transmission IDU 29 25.0 MSM 19 16.4 Heterosexual 47 40.5 Perinatal 1 0.9 Transfusion 1 0.9 Other/Not Specified 19 16.3

24 EPIDEMIOLOGY

The mission of Epidemiology is to provide 2011, Epidemiology took the lead on the Health Department and the community at tuberculosis contact investigations in New large with information for evidence-based Haven. public health action. In addition to routine monitoring, Epidemiology monitors data to assess the Epidemiology provides information on health of New Haven citizens and to identify particular issues of public health concern in potential health problems. For example, New Haven. In 2011, as part of the Health certain infectious diseases are reportable to Equity Alliance and HealthMatters!, the Department. These reports are reviewed Epidemiology lead the development of a to understand the extent and nature of these report on the public health impact of obesity conditions and to identify potential in New Haven. Epidemiology also began a outbreaks. study of the development of obesity in a cohort of New Haven school children. Epidemiology examines vital records to better understand the residents’ health. In 2011, Epidemiology participated in the Death certificates are reviewed weekly as development of a Community Health Needs part of the CDC 122 Cities influenza and Assessment and Health Improvement pneumonia surveillance. Using death and Planning process for New Haven in birth certificate data, important community collaboration with Yale New Haven Hospital, health indicators are examined including Hospital of Saint Raphael, Yale School of infant mortality, teenage pregnancy, and Public Health, the New Haven Federally leading causes of death. Qualified Health Clinics and DataHaven.

Epidemiology participates in the Finally, the monitoring and control of disease investigation and control of infectious and injury are important aspects of public diseases. For example, people with emergency disaster preparedness and foodborne disease are interviewed to help response. Epidemiology provides technical prevent the spread of disease and identify assistance for emergency planning, potentially contaminated food items. In exercises, and response.

25 Reported Communicable Diseases, New Haven, 2005 - 2011*

2005 2006 2007 2008 2009 2010 2011* Chlamydia 1,405 1,421 1,460 1,572 1,505 1,419 1,531 Giardiasis 16 14 20 8 13 14 12 Gonorrhea 361 421 397 582 448 342 301 Hepatitis A 3 5 0 0 0 0 2 Hepatitis B (Acute) 5 2 3 3 1 5 3 Hepatitis B (Chronic) 20 34 24 40 43 23 34 Hepatitis C (Acute) 4 2 0 0 2 2 2 Hepatitis C (Chronic/Resolved) 191 187 168 170 126 119 130 Legionnaires' Disease 2 1 2 2 4 2 7 Measles 0 0 0 0 0 0 0 Meningococcal Disease 1 0 1 0 0 0 0 Mumps 0 0 0 0 0 3 0 Salmonellosis 14 21 22 22 21 19 21 Shigellosis 1 5 5 0 1 3 4 Syphilis (primary/secondary) 15 6 6 9 4 16 9 Tuberculosis 6 6 10 8 11 4 5 Whooping Cough (Pertussis) 4 3 4 1 0 1 0

*2011 - Data provisional as of February 2012 NR = Not reportable NA = Not available at time of report

26 Chlamydia Laboratory Reports, New Haven Residents, 2011

Female Male Total Age N % N % N % 0-9 1 0.1 0 0 1 0.1 10-14 20 1.8 3 0.7 23 1.5 15-19 443 39.8 126 30.1 569 37.2 20-24 404 36.3 141 33.7 545 35.6 25-29 143 12.8 79 18.9 222 14.5 30-34 49 4.4 26 6.2 75 4.9 35+ 53 4.8 42 10.0 95 6.2 Unknown 0 0.0 1 0.2 1 0.1 Total 1,113 100.0 418 100.0 1,531 100

Race/Ethnicity N % Black 794 51.9 Hispanic 237 15.5 White 87 5.7 Other 8 0.5 Unknown 405 26.5 Total 1,531 100.0

Gonorrhea Laboratory Reports, New Haven Residents, 2011

Female Male Total Age N % N % N % 0-14 4 2.5 3 2.2 7 2.3 15-19 60 36.8 24 17.4 84 27.9 20-24 50 30.7 45 32.6 95 31.6 25-29 30 18.4 29 21.0 59 19.6 30+ 19 11.7 37 26.8 56 18.6 Unknown 0 0.0 0 0.0 0 0.0 Total 163 100.0 138 100.0 301 100.0

Race/Ethnicity N % Black 200 66.4 Hispanic 20 6.6 White 14 4.7 Other 0 0.0 Unknown 67 22.3 Total 301 100.0

* Data provisional as of February 2012

27 VITAL STATISTICS

The Department’s Office of Vital Statistics Revenue from the Office is generated from preserves and records all births, deaths, civil the distribution of certified copies, permits unions and marriages that occur in the City and licenses to the public. of New Haven or that occur outside of the The Bureau has daily interaction with the City to New Haven residents. Adoptions, public and a variety of federal, state, and legal changes of name, and amendments local agencies that require information are also recorded. pertaining to vital records. Original records Resident copies are sent to the cities and dating from 1649 are stored and maintained towns in Connecticut for those people who in the Bureau’s vault. Computerized storage are not New Haven residents but had an of files began in 2003. event that occurred in New Haven.

New Haven Vital Records Transactions and Revenue, 2011

Records Issued Number Total Charge Marriage License 1,225 $36,750 Marriage License Same Sex 73 $2,190 Certificate of Marriage 2,151 $42,980 Civil Union License 0 0 Certificate of Civil Union 0 0 Certificate of Death 10,888 $217,760 Burial Permits 1,895 $5,685 Certificate of Birth 17,148 $342,840 Certificate of Birth Wallet 2,502 $37,455 Disinterment Permits 8 $24 Cremation Permits 700 $2,100 Search Fee 0 0 Town Copies 1,015 $6,901 TOTAL 37,605 $694,685

28 PREVENTIVE MEDICINE

The goal of Preventive Medicine is to trace WEST NILE VIRUS disease patterns and their origins. The West Nile Virus was detected in the region at objective is to avoid morbidity and mortality the end of the summer season. Two in New Haven residents by controlling and individuals were diagnosed with the disease investigating communicable diseases known in September. to threaten the public’s health. Specific SEXUALLY TRANSMITTED DISEASES CLINIC clinics are held to diagnose and treat In 2011, the STD Clinic saw a total of 910 diseases controllable by public health patients. This was a decrease of 18% from measures. The Department provides a the previous year’s total. central surveillance resource for information related to communicable disease. Gonorrhea and Chlamydia. The clinic diagnosed 34 cases of gonorrhea and 98 The Health Department offers specialized cases of Chlamydia. Again, gonorrhea clinics to provide information, prophylaxis continues to be at one of the lowest levels and treatment related to flu protection, for the past decade. tuberculosis testing, STD screening, HIV counseling/testing and adult immunizations. HIV Counseling and Testing. The STD The following are a summary of significant Clinic continues offering individuals HIV events in the past year. counseling and testing. All patients entering the clinic received basic counseling H1N1 AND INFLUENZA regarding HIV prevention. This year 824 The majority of the flu cases in the 2010-11 individuals agreed to testing (90.5% of winter were the Seasonal Flu variety and the clients). All of the testing used a Rapid Test H1N1 strain was only a minor participant. reagent and the patients were able to However, H1N1 still continued to be included receive the results during their clinic visit. in the vaccine’s strains to increase general Two (2) individuals tested positive for the immunity in the population. The Health HIV virus in the STD Clinic and they were Department distributed more than 400 given appropriate advice and follow-up seasonal flu vaccines at sites throughout the referrals. The State Department of Public community, including Senior Citizens Health CARE Program has a satellite office Centers, City Hall, Ecuadorian Consulate, in the clinic and counsels any individual who and the Health Department clinic. has had sexual contact with persons newly diagnosed with HIV infections.

29 Due to the complexity of analysis, most TUBERCULOSIS HIV/AIDS data is delayed by one year. At In 2011, the City documented five (5) cases the end of 2010 (last reporting year), New of mycobacterium tuberculosis. This is a Haven had 41 newly diagnosed cases of 16% reduction from the previous year. City- HIV/AIDS infection reported. Although the wide, tuberculosis continues to be at its data is premature, at the end of 2011, 1,504 lowest historical level, usually ranging from 6 individuals were currently living in the City to 11 cases. One individual has been with HIV/AIDS. By the end of 2011, New identified as having a multi-drug resistant Haven had 3,067 cumulative cases of strain that has required long-term HIV/AIDS since reporting started in 1982. intravenous therapy besides oral drug

Syphilis. The clinic performed seven 746 treatment. In the USA, tuberculosis tends to syphilis tests. Twenty-eight (28) tests were occur in immigrant populations from initially positive and required confirmatory countries with endemic tuberculosis and four testing at the State. City-wide, nine (9) cases of the five pulmonary cases were from of primary and secondary syphilis were foreign born individuals. One case was reported for 2011. This represents a 44% diagnosed outside of the City and decrease from the previous year. Only three transferred to care in the City. All of the (3) cases of early latent syphilis were cases were treated by a DOT protocol documented. All of the syphilis cases were (Directly Observed Therapy) performed by a in males having sex with males (MSMs). As nurse. with gonorrhea, the number of syphilis cases diagnosed in City residents is significantly low compared to prior years.

30 EMERGENCY PREPAREDNESS

The Office of Emergency Preparedness TROPICAL STORM IRENE RESPONSE works closely with the New Haven On August 28, 2011, Tropical Storm Irene hit Emergency Operations Center to ensure the the coast of Connecticut causing widespread City of New Haven responds effectively to power outages, flooding, fallen trees, and natural disasters, acts of terrorism, and other debris across New Haven. Health emergencies that could affect the public’s Department staff responded to the declared health. This mission is achieved through emergency as part of a robust response planning, training, educating, and effort led by the City Emergency Manager collaborating with local, regional, state, and out of the Emergency Operations Center. community stakeholders. Department staff distributed public health information; delivered food, water and ice to EMERGENCY PREPAREDNESS EXERCISES citizens in need; and inspected and In 2011, the Office strived to build monitored food establishments to ensure relationships with private organizations and food safety. to improve capacity to deliver life-saving

medication in the event of a public health EMERGENCY PREPAREDNESS ACTIVITIES emergency requiring such an intervention. The Office undertook a number of activities Over the course of a year, the Office hosted to prepare for public health emergencies, planning meetings, seminars and including: workshops, which culminated in a regional,  Participating in a Technical Assistance full-scale exercise entitled “Rad-X.” The goal Review. This annual review is performed of the initiative was to give appropriate with regional, state, and federal partners to antibiotic prophylaxis to critical staff of local identify strengths and weaknesses in the government, community institutions, and Department’s plans to conduct mass their families, quickly enough upon dispensing. recognition of a confirmed anthrax attack to  Working with community partners such as protect responders and to off-set the number Cornell Scott-Hill and Fair Haven Health of people who will be asked to come to the Centers, Yale University, and the Regional public point of dispensing site. This exercise Water Authority to plan for mass demonstrated that the Health Department dispensing. can distribute and dispense medications in a  Working with City departments to plan for timely manner and communicate effectively the dispensing of medications in response within established City and State to a public health emergency in order to communication channels. maintain critical government operations.

31 Other public health emergency such as disaster preparedness, product preparedness activities included: recalls, water shortages, and floods.  Updating the Department’s Emergency  Preparing for public health emergencies by Response plan. The plan outlines how participating in seminars, drills, and essential public health services would be exercises. maintained during a disaster.  Providing flu vaccine clinics in the  Providing educational materials at public community and to City employees in health fairs and community sponsored collaboration with the Health Department’s events. Public Health Nurses and Preventive  Recruiting and training volunteers, staff, Medicine staff. and community stakeholders in emergency  Participating in emergency response response planning and practices. The operations at the City’s Emergency Department has 118 confirmed Emergency Operations Center. Response Team volunteers.  Maintaining the City’s emergency information webpage in collaboration with the New Haven Office of Emergency Management (OEM) on a variety of topics,

32 ADMINISTRATIVE SERVICES

Under the leadership of the Director of from other sources to improve the level of Public Health, Department staff work public health services offered to the citizens diligently to carry out the essential public of New Haven without increasing the burden health services. These include: monitoring of cost to the taxpayer. Special funds the health status of the community; secured by the Department from federal, investigating health problems; informing, state, and foundation grants totaled educating and empowering the community $15,911,601. The Department has a total of concerning health issues; mobilizing 88 employees, 56 are general fund and 32 partnerships; developing policies and plans are special fund positions. to address health concerns; enforcing public New Haven Health Department by Numbers, 2011 health laws and regulations; assuring a Personnel Number General Fund 56 competent health care system; evaluating Special Fund 32 the effectiveness of existing programs and Total 88

services; and researching new opportunities Budget Dollars General Fund $3,075,491 to deal with identified health problems and Special Fund $15,911,601 issues. Fees Revenue $900,000

Special Fund Source Dollars In cooperation with the Director of Public Federal $14,143,771 Health, fiscal staff manage and oversee the State $1,353,361 Other $414,469 Department’s finances, both general and Total $15,911,601 special funds. Staff also assures compliance The Department generated $900,000 with City administrative requirements and through various fees charged for services with requests from grantee agencies and rendered (e.g., clinic fees), permits issued maintains fiscal responsibility and (i.e., food service licenses, vital records, pool accountability for both the general operating permits, day care center inspections), and budget and each special fund account. reimbursement from the State of Connecticut The Department was appropriated for school health services provided to non- $3,075,491 from the City’s general funds public schools. (local tax dollars) for the fiscal year July 1, 2011 to June 30, 2012. The Department obtains supplemental funding each year

33

Distribution of General Funds, FY 2011

Nursing 51.94%

Env ir onmental 12.03%

Equipment 0.17%

Vital Stats 7.32% Maintenance 0.20% Health Programs Administration Clerical Clinic/Lab Pr inting 5.28% 4.79% 3.84% 5.14% 0.24% Transportation Distribution of Special Funds 0.26% Epidemiology Supplies 2.57% Overhead 0.74% 0.82% MCH PH Preparedness 2.43% 2.22%

Distribution of Special Funds, FY 2011

Ryan White 82.34%

HOPWA MCH Health Education 6.30% STDs* 0.17% 5.59% 1.6% Tuberculosis 0.40%

Environmental Health Emergency 1.56% Preparedness State Health Subsidy Asthma 0.53% 0.92% 0.59%

*STDs includes funding for HIV prevention and Syringe Exchange programs

34 New Haven Health Department Organizational Chart - 2011

35 New Haven Health Department Contact Information

HEALTH DEPARTMENT Mario Garcia, MD, MSc, MPH, Director of Public Health Program Description Contact Person Health Matters! Health Matters! is an ambitious movement to improve the Dr. Mario Garcia: health status of New Haven by 1) changing the way 203-946-6999 communities talk about health, 2) supporting health promoting initiatives, policies and programs in New Haven and 3) creating health positive policy in New Haven. Administrative Under the leadership of the Director of Public Health, Laura Mattaliano: Services administrative staff conduct assessment, program 203-956-5138 planning and policy development to address the health needs of the community; manage and oversee fiscal and Pamela DeZutter: personnel activities; research and procure resources; 203-946-8169 assure compliance with state and federal mandates and City requirements; develop and coordinate partnerships, and collaborations. Public Health Emergency Preparedness Program Description Contact Person Public Health The Office of Emergency Preparedness works to ensure Cristie Duric: Emergency the City of New Haven responds effectively to natural 203-946-8457 Preparedness disasters, acts of terrorism and other emergencies that could affect the public’s health. This mission is achieved through planning, training, educating, and collaborating with local, regional, state, and community stakeholders. Maternal and Child Health Provides bicultural/bilingual community-based outreach and case management support for pregnant and parenting women and their families to successfully access health and other support services. Program Description Contact Person HUSKY, Free DSS funded program to assist pregnant women apply for Main Office: Care, Me and My prenatal care, and receive short term, limited care 203-946-8187 Baby Insurance coordination, a comprehensive risk assessment and Maria Damiani: Application appropriate referrals and follow up. HUSKY applications 203-946-5842 Assistance at St. Raphael's and YNNH. Nurturing NFN is a DSS funded statewide system of continuous Main Office: Families Network care designed to promote positive parenting and reduce 203-946-8187 (NFN) (Children's incidences of child maltreatment for the highest risk first Maria Damiani: Trust Fund) time parents. Components of the program include a focus 203-946-5842 on fathers, support groups, (teen and co-ed), and weekly Kathleen Hagearty: home visiting. 203-946-5754 New Haven Federally funded program to improve birth outcomes and Main Office: Healthy Start reduce health inequities for AA women and high risk 203-946-8187 (CFGNH) undocumented women through outreach, case finding, Maria Damiani: care coordination 203-946-5842 MANOS DSS funded intensive case-management, family re- Main Office: (Maternal and unification, medical transportation. Advocacy, referrals for 203-946-8187 Newborn employment, training and housing, DCF collaboration. Maria Damiani: Outreach 203-946-5842 Support) LaRonda Winfrey- Program Osimeh: 203-946-7480

36 New Haven Health Department Contact Information

Health Information Services Program Description Contact Person Epidemiology Epidemiology collects, analyzes and dissseminates data Amanda Durante that provides the New Haven Health Department with 203-946-8239 information for action. Activities include: (a) Monitoring and collecting epidemilogic information on reportable disease/ laboratory findings and deaths; (b) Analyzing vital statistics and other routinely available datasets (e.g. school nurse records, hospital discharge records); (c) Collecting data on the health of populations in New Haven using surveys and other methodologies; (d) Working as part of a team to investigate and control infectious and noninfectious disease outbreaks/problems; (e) Providing information to City of New Haven colleagues, clinicians and the public on disease and appropriate control measure. Vital Statistics Records all births, deaths, marriages, adoptions, Lisa Wilson: affidavits of parentage & legal changes of name 203-946-7931 occurring in New Haven. Marriage licenses & permits for burial, disinterment & cremation are also issued. Elm Address: City Resident Card also issued through Vital Stats. 165 Church Street Office of New The ONHR has become the premier location for City Lisa Wilson: Haven Residents residents to find all they need to know about New Haven. 203-946-7931 The office prides itself in providing residents with the personal touch needed while navigating all City Address: resources. Residents of New Haven can come to City 165 Church Street Hall and seek assistance, information and orientation in a number of areas, including health, education and city services. As such, staff has created an Information Center, which is stocked with topic specific information. Welcome packages have been developed covering a broad range of topics. Health Programs Division Program Description Contact Person Safe Kids Greater The Health Education Assistant co-leads the Greater Mary Ann Zavorskas: New Haven New Haven Chapter of Safe Kids CT with a Quinnipiac 203-946-8186 University Professor, Tracy Van Oss, in the Occupational Therapy Program. Safe Kids is a worldwide program which focuses on reducing unintentional death and injury among children 14 years and younger. Safe Kids Greater New Haven co-leaders work together with other community child safety advocates to provide child safety services. Bi-annual meetings are held with community partners and Chapter representatives participate in safety fairs, car seat check events, and other community child safety events. Typically, Chapter activities focus on child passenger safety, child residential safety, pedestrian safety, bicycle safety and other child safety topics. Many child safety educational materials are distributed at events in New Haven and surrounding towns and Chapter co-leaders serve as a resource to parents for child safety information.

37 New Haven Health Department Contact Information

Health Programs Division (continued) Program Program Program Child Passenger Child Passenger Safety Presentations for parents/ Mary Ann Zavorskas: Safety caregivers are conducted in the New Haven community. 203-946-8186 Presentations These presentations provide basic information about car seat use and encourage parents to obtain assistance with the installation of their car seats from certified child passenger safety technicians at local "car seat fitting stations." A variety of child safety educational materials are provided at the presentations, typically conducted at New Haven school readiness and Head Start sites. Child Residential The Program's goal is to reduce home-based injuries Mary Ann Zavorskas: Safety Program among children under the age of six years. Outreach staff 203-946-8187 conduct home safety visits in the homes of their clients. Utilizing a checklist, staff work with parents to identify and correct hazards that threaten the safety of their young children. Safety supplies to correct the indentified hazards and child safety educational materials are provided. Follow-up is conducted to ensure identified hazards are corrected and corrective action was taken by the landlord, if required. Healthy Corner The Initiative’s goal is to improve residents’ access to Mary Ann Zavorskas: Store Initiative healthy foods by encouraging proprietors of local corner 203-946-8188 stores to stock a variety of healthy food options, including fresh produce. Stores are selected to participate in the program based upon their proximity to schools and the proprietor’s level of interest. Each proprietor is provided with education, support, and follow-up contact to ensure the successful implementation of the program. Smoke-Free The aim of the Smoke-Free Housing Initiative is to Brooke Logan: Housing reduce tenants' exposure to secondhand smoke by 203-946-8351 increasing the number of multi-unit dwellings with smoke- free policies. Syringe This program offers a one-to-one syringe exchange while Brooke Logan: Exchange providing injection drug users with the necessary 203-946-8351 Program information and supplies to reduce their risk of acquiring or transmitting HIV/AIDS. Condoms, ties, cookers, distilled water, and anti-bacterial creams are dispensed. HIV counseling and testing is offered along with referrals and transportation to substance abuse treatment facilities. Referrals to medical and social support services are also provided. HIV Counseling The Program’s goal is to provide New Haven residents Patrick Armstrong: and Testing with HIV counseling and testing services that is 203-946-6453 confidential and free of charge. HIV counseling and testing is offered Monday-Thursday at the New Haven Health Department and throughout the community. AIDS Education This program aims to reduce the transmission of Brooke Logan: and Outreach HIV/AIDS by educating New Haven residents about the 203-946-8351 importance of reducing risk behaviors. Education and outreach is conducted through the use ofsStreet outreach, couples counseling for men who have sex with men, and two group programs, Safety Counts and VOICES/VOCES.

38 New Haven Health Department Contact Information

Ryan White Part A Ryan White Part Administers federal funding for HIV/AIDS care throughout Thomas Butcher: A Office New Haven and Fairfield Counties. The funding is 203-946-7388 distributed to agencies throughout the two counties to provide services to people living with HIV/AIDSs. Services are mandated by the Federal Human Resources and Services Administration (HRSA). Seventy-five percent (75%) of all funding must go to “core” services (primary medical care, mental health, substance abuse treatment, medical case management, oral health, and health insurance) and 25% of funding is allocated to “support” services which must be linked to medical outcomes (medical transportation, outreach, emergency financial assistance, housing assistance, and food-bank home delivered meals). Bureau of Nursing Program Description Contact Person School Health The Bureau of Nursing provides school health services Director: Services for New Haven public and non-public schools and staffs 203-946-6364 one school-based health clinic. School health services include but are not limited to: immunizations and physical exam compliance tracking; vision and hearing screenings; first aid (trauma, allergies); diagnosis & treatment of illness & injuries; medication dispensing; and individualized health care plans development. The school-based health center provides additional services, such as immunizations and physical examinations. Asthma The Asthma Program was developed to address issues Farzaneh Valipour: Program/Triggers as they pertain to asthma as well as to focus on 203-946-6365 be Gone education, prevention and self-management of the disease. Our Triggers Be Gone program provides families with medical equipment and asthma triggers reduction supplies. The program is collaborating with the Department's Bureau of Environmental Health on the Green and Healthy Homes initiative. Pediatric Tracking and outreach of immunizations for children up to Jennifer Hall Immunizations 24 months of age. 203-946-7097 CIRTS Registry Bureau of Environmental Health Lead paint, water testing, food service inspections, investigate public health concerns and dangers. Program Description Contact Person Licensing and To ensure periodic inspection of all licensed food-service Paul Kowalski: Inspection of establishments operating within the city and achieve 203-946-8174 Food-Service compliance with the State Public Health Code Establishments Lead Hazard To investigate and resolve all cases of childhood lead Paul Kowalski: Control and poisoning reported to the department in a timely manner 203-946-8175 Childhood Lead and to seek and distribute federal funding to lead abate Poisoning housing units occupied by income-qualified families Prevention Public Heath To investigate and resolve public health Paul Kowalski: Nuisances/threats nuisances/hazards and infractions of applicable statutes 203-946-8176 and/or ordinances punctually and competently.

39 New Haven Health Department Contact Information

Bureau of Environmental Health (continued) Program Description Contact Person Monitor Water To provide adequate monitoring of water quality of all Paul Kowalski: Quality of Public public swimming pools within the city and of the waters 203-946-8177 Swimming Pools off of Lighthouse Point Park and Bathing areas Inspect schools, To provide a bi-annual inspection of all city schools to Paul Kowalski: daycare centers, ensure the health and safety of the student population. 203-946-8178 summer lunch To periodically inspect day care centers, group homes, feeding sites senior centers and summer lunch feeding sites and achieve compliance with the State Public Heath Code. Weights and Safeguards public health and promotes public welfare by Kristen Bayer: Measures protecting consumers in all monetary transactions using 203-946-4892 weight, measure or count. The mission is to ensure consumers in New Haven are paying for accurate weights and measures of goods and services. This includes gasoline, taxi cabs, laundromats, and all purchases made in grocery stores within our jurisdiction. Staff inspect all commercial weighing and measuring devices designated as “legal for trade” to assure they are maintained within the acceptable tolerances as defined by State and Federal law. Staff serves as a consumer advocate by investigating any concerns or complaints relative to questionable selling prices. Preventive Medicine Specific clinics are held to diagnose and treat diseases controllable by public health measures. The Department provides a central surveillance resource for information related to communicable diseases. Weekly clinics offer appropriate adult and child immunizations. Program Description Contact Person Immunization Specialized clinics to provide information, prophylaxis Fred V. Gager: Clinic and treatment related to flu protection. The Department 203-946-8184 offers weekly Immunizations to adults and children Main Line: 203-946-8182 Sexually Evaluation and treatment for Sexually Transmitted Fred V. Gager: Transmitted Diseases. Special clinic are held 3X/week with 203-946-8184 Disease Clinic Infectious Disease Specialists. Main Line: 203-946-8183 Disease In cooperation with the CT Department of Public Health, Wanda Richardson: Intervention the Health Department provides individual counseling to 203-946-7233 Specialists (DIS) the network fo contacts of STD and/or HIV positive patients. Tuberculosis The Department works with the health care provider Fred V. Gager: Prevention and community and State officials to identify all active cases 203-946-8184 Monitoring of tuberculosis, conduct contact investigations, and Main Line: administer Directly Observed Therapy to treat the 203-946-8182 disease in the appropriate time. The Department assists in transportation to clinics when needed. Tuberculosis skin testing is offered to the community.

40 NEW HAVEN BOARD OF HEALTH

John DeStefano, Jr. Tamiko Jackson-McArthur, MD Mayor, City of New Haven Pediatrician

Katrina Clark, MPH Heather Reynolds, CNM, MSN Fair Haven Community Health Center Yale School of Nursing

Reid Davis, RPh, MPH James Hadler, MD, MPH Former State Epidemiologist

NEW HAVEN HEALTH DEPARTMENT EXECUTIVE STAFF

Mario Garcia, MD, MSc, MPH Director of Public Health

OFFICE OF THE DIRECTOR EMERGENCY PREPAREDNESS

Pamela DeZutter Cristie Duric, MPH, RRT, MEP Fiscal Administrative Assistant Public Health Preparedness Coordinator

Laura Mattaliano, MPH Special Assistant to the Director of Health MATERNAL AND CHILD HEALTH

Maria Damiani, MS HEALTH PROGRAMS DIVISION Maternal and Child Health Director

Brooke Logan, MPH Kathleen Hagearty, LCSW Health Programs Director Project Coordinator, Nurturing Families Network

Thomas Butcher, MEd LaRonda Winfery Ryan White Part A Project Director Healthy Start Supervisor, Healthy Start

CLINIC AND LABORATORY SERVICES INFORMATION SERVICES

Fred Gager, MD Amanda Durante, PhD, MSc Medical Advisor Epidemiologist

Maureen Bruce, RN Lisa Wilson Public Health Nurse, Clinic City Registrar of Vital Statistics

Vacant Laboratory Technician Administrator PUBLIC HEALTH NURSING

Vacant ENVIRONMENTAL HEALTH Public Health Nursing Director

Paul Kowalski, MPH, RS Jennifer Hall Environmental Health Programs Director Immunizations Coordinator

Kristen Bayer, MALS Farzaneh Valipour Sealer, Weights and Measures Asthma Project Coordinator

41 CITY OF NEW HAVEN BY NEIGHBORHOOD

42

Produced by: The New Haven Health Department Chisara N. Asomugha, MD (Acting) Director of Heallth Developed by the New Haven Health Department.

New Haven Health Department 54 Meadow Street, 9th Floor New Haven, CT 06519 (203) 946-6999 www.cityofnewhaven.com/health